Effects of Nicotine Patches on Early and Late Attentional Bias to Smoking Cues: We May Know Less Than We Think

In contrast to overnight deprivation versus satiety studies, a small number of placebo-controlled studies have failed to find that nicotine administration reduces attentional bias (AB) to smoking cues. To assess the reliability of this failure and to address the duration and salience of AB in smokers versus never-smokers, we used a longer-than-typical (i.e., 3,000 ms) smoking cue-presentation time in a placebo-controlled trial of smokers and never-smokers. We aimed to assess whether a nicotine patch (i.e., active vs. placebo) attenuates continuously assessed eye gaze-measured AB to smoking cues across 3,000 ms in 32 habitual, overnight-deprived smokers and smoker-nonsmoker differences compared to 32 never-smokers. We presented a series of picture pairs (i.e., one smoking-related and one affectively neutral control picture) simultaneously to assess AB. Participants attended a 14 mg nicotine patch and a placebo patch session in a randomized order. The habitual smokers were 12-18 hr nicotine-deprived during both sessions. Smokers demonstrated a stronger AB toward smoking cues than never-smokers across the entire 3,000 ms cue-presentation time. Nicotine did not significantly reduce the AB to smoking cues but the AB was strongly and positively related to deprivation-associated cravings in smokers. Patch-delivered nicotine did not reduce AB to smoking cues presented for up to 3,000 ms, even though smoker-nonsmoker differences in bias remained. Assessments of longer cue presentations and more subtle cues may provide nuance not currently captured by existing studies, because of potential demand effects in designs that contrast overnight versus sated state effects on AB. Public Health Significance The present study demonstrates that nicotine replacement therapy (NRT) did not affect attentional bias to smoking cues across a period longer than previously assessed in the literature, even though attentional bias was related to craving; previous research shows that this factor predicts relapse. This lack of an effect of NRT across 3,000 ms of eye gaze assessed attentional bias combined with similar findings over shorter assessment periods suggests that clinical interventions other than NRT may need to reduce attentional bias and promote abstinence.